Trade agreements are being used to “handcuff governments” over health policy, Margaret Chan, director-general of the World Health Organisation said at its assembly. This was “disturbing” she went on, adding that trade agreements have many consequences for health.
A nation’s health can be benefited by such deals, whether by increasing exports to foreign markets, bringing in foreign investment, or reducing the price of imported goods. But for all this potential good, they can also do just as much harm if their impact on health isn’t considered when they are being designed and negotiated. The Trans Pacific Partnership (TPP), currently under negotiation, is one such agreement that has caused big debate over proposals that included patenting medical procedures.
A deal is a deal
Trade agreements are essentially wide-ranging tax, tariff and trade treaties between two or more countries that often include investment guarantees. This means that there are myriad ways that a trade agreement could put a population’s health at risk by prioritising one gain over another.
For example, Samoa lobbied for 13 years before it was admitted to the World Trade Organisation in 2011, which opened up enormous opportunities for growth and development. Yet many leaders still express their disgust as to the reason that kept Samoa from joining the WTO for so long: fatty turkey tails.
Flaps, scraps and turkey tails
Turkey tails – much like chicken frames (the bones and scraps from the carcass) or New Zealand’s mutton flaps – are high-fat off-cuts of the food manufacturing industry that are sold mainly in low and middle-income countries. Samoa was instructed by the WTO that it had to lift a ban on importing the fatty delight if it wanted to become a member.
Many issues like this have stemmed from an international agreement called the Trade Related Aspects of Intellectual Property Rights, commonly known as TRIPS, which was signed in 1994. TRIPS is administered by the WTO and the agreement sets down minimum standards for many forms of intellectual property (IP) regulation applied to nationals of other WTO Members.
While the WHO has tried to provide technical assistance and support for countries implementing TRIPS in a way that is consistent with protecting public health, such as having access to medicines, it can only do so much against the spending power of multinational corporations.
The evidence clearly shows that investing in health leads to enormous economic and cost-effective benefits. Yet governments can find it difficult to strike the right balance between maintaining a fair and equitable market while also satisfying public health interests.
Even when trade exclusions are put into place to protect public interests, such as parallel importation, which allows a country to import a patented product without the consent of the patent-holder, these are not always enough. Multinational corporations have a history of finding ways around these safeguards, particularly in low and middle-income countries, and governments often find it difficult to stand up to big industry.
Philip Morris v Uruguay
One exception to this is the current case between tobacco giant Philip Morris International and the Uruguayan government.
Uruguay, which has a GDP of US$44 billion, imposed anti-smoking warnings on cigarette packs. Philip Morris, with a total share value of US$108 billion, is suing the government on the grounds that its actions cause the company harm. The Uruguayan government has refused to back down, despite Philip Morris alleging that the packaging labels breach the intellectual property laws of trade agreements between Uruguay and countries where Philip Morris has offices.
Other governments are also trying to prioritise the public’s health, such as in the case concerning a trade agreement between Peru and the US. Lead-mining giant Renco is currently suing the Peruvian government after it was ordered to clean up pollution. Yet another example concerns the free trade agreement between the US and Central America and a legal case between gold-miner Pacific Rim and the El Salvadorian government. The company lodged a US$301m challenge because it was refused a mining license for environmental reasons.
Essential medicines
But the biggest issue at the heart of the arguments over trade agreements is undoubtedly access to essential medicines. Chan called on governments to position public health, and especially medicines and treatments, as a central pillar of international trade agreements.
Some member states have expressed concern that trade agreements currently under negotiation could significantly reduce access to affordable generic medicines. If these agreements open trade, yet close access to affordable medicines, we have to ask: ‘Is this really progress at all, especially with the costs of care soaring everywhere?’
Many people in the world still lack effective access to essential medicines. The WHO has tried to address this by placing blockbuster and cost-effective drugs on its own essential medicines list, which acts as a valuable guide for others at a national and institutional level. Updated every two years since 1977, the list aspires to give people everywhere access to safe and effective medicines and health products.
Such initiatives can do much to curb the barriers to living a healthier life, but as the debate continues between public health needs versus trade, it is clear that we need to lobby more to put health on the trade agenda – particularly with so many of these negotiations happening behind closed doors.